Diffuse idiopathic skeletal hyperostosis is associated with incident stroke in patients with increased cardiovascular
Netanja I Harlianto1,2, Nadine Oosterhof1, Wouter Foppen1
1Department of Radiology.
Insights
Diffuse idiopathic skeletal hyperostosis (DISH) is linked to a higher risk of ischemic stroke. This study found DISH independently associated with increased stroke incidence, but not other major cardiovascular events or mortality.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- Diffuse idiopathic skeletal hyperostosis (DISH) is a condition with suggested links to cardiovascular disease.
- Previous studies indicate a potential association between DISH and myocardial infarction.
- This research investigates the relationship between DISH and cardiovascular events in high-risk individuals.
Purpose of the Study:
- To assess the association between DISH and the incidence of cardiovascular events.
- To evaluate the impact of DISH on mortality rates in patients with high cardiovascular risk.
- To determine if DISH is an independent risk factor for specific cardiovascular outcomes.
Main Methods:
- A prospective cohort study involving 4624 patients from the Second Manifestations of ARTerial disease cohort.
- Major adverse cardiovascular events (MACE), all-cause mortality, and separate vascular events were tracked.
- Cause-specific and subdistribution hazard models were employed, with adjustments for multiple cardiovascular risk factors.
Main Results:
- Diffuse idiopathic skeletal hyperostosis (DISH) was identified in 9.4% of the study population.
- Over a median follow-up of 8.7 years, DISH was significantly associated with an increased cumulative incidence of ischemic stroke.
- No significant association was found between DISH and overall MACE, myocardial infarction, vascular death, or all-cause mortality after adjustment.
Conclusions:
- The presence of DISH is independently associated with an increased incidence and risk for ischemic stroke.
- DISH does not appear to be a significant independent predictor for major adverse cardiovascular events, myocardial infarction, vascular death, or all-cause mortality.
- This study highlights a specific cardiovascular risk associated with DISH, namely ischemic stroke.
Objectives:
Earlier retrospective studies have suggested a relation between DISH and cardiovascular disease, including myocardial infarction. The present study assessed the association between DISH and incidence of cardiovascular events and mortality in patients with high cardiovascular risk.
Methods:
In this prospective cohort study, we included 4624 patients (mean age 58.4 years, 69.6% male) from the Second Manifestations of ARTerial disease cohort. The main end point was major cardiovascular events (MACE: stroke, myocardial infarction and vascular death). Secondary endpoints included all-cause mortality and separate vascular events. Cause-specific proportional hazard models were used to evaluate the risk of DISH on all outcomes, and subdistribution hazard models were used to evaluate the effect of DISH on the cumulative incidence. All models were adjusted for age, sex, body mass index, blood pressure, diabetes, non-HDL cholesterol, packyears, renal function and C-reactive protein.
Results:
DISH was present in 435 (9.4%) patients. After a median follow-up of 8.7 (IQR 5.0-12.0) years, 864 patients had died and 728 patients developed a MACE event. DISH was associated with an increased cumulative incidence of ischaemic stroke. After adjustment in cause-specific modelling, DISH remained significantly associated with ischaemic stroke (HR 1.55; 95% CI: 1.01, 2.38), but not with MACE (HR 0.99; 95% CI: 0.79, 1.24), myocardial infarction (HR 0.88; 95% CI: 0.59, 1.31), vascular death (HR 0.94; 95% CI: 0.68, 1.27) or all-cause mortality (HR 0.94; 95% CI: 0.77, 1.16).
Conclusion:
The presence of DISH is independently associated with an increased incidence and risk for ischaemic stroke, but not with MACE, myocardial infarction, vascular death or all-cause mortality.
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